Patient Power
You’re buying a car. You compare models and prices; even take one for a test drive. You’re considering a new high-def screen TV. You ask your friends if they like theirs . You mull the amazing choices at the local electronics store. You read up on all the reviews and buy the one that fits your family room.
Now, your doctor says you need surgery. What questions should you be asking to make sure you get the best value and the features you want? And can surgery really be treated like a major purchase?
“Yes, patients have control and they need to exercise it,” says Douglas Khoury, M.D., F.A.C.S., a Davenport general surgeon and partner in the Mississippi Valley Health Network. “You need to consider that you are actually purchasing a service, which is more important than any item you could possibly buy. Asking the right questions helps you control surgery costs, limits scarring, and allows you to return to your normal activity level as soon as possible,” explains Dr. Khoury.
Get smart – Look for board certified surgeons
Your doctor has recommended that you be evaluated by a surgeon. How do you find the surgeon who is best for you? First, select a surgeon who is board certified in a specialty recognized by The American Board of Medical Specialties. This can be verified on the Internet (http://www.abms.org) which can also help you locate board certified surgeons in your community. Primary care physicians, friends, and family members can often provide valuable information helpful in selecting the surgeon best for you.
The letters “FACS” after a surgeon’s name indicate that he or she is a Fellow of the American College of Surgeons (ACS). According to the Chicago based ACS, “Fellows are board certified surgeons whose education, training, professional qualifications, surgical competence and ethical conduct have met the highest standards…not all surgeons are accepted.” Another factor to consider is whether or not a surgeon has undergone subspecialty training better known as fellowship training. This identifies surgeons who have undergone more directed training within a certain specialty. Fellowship training goes beyond board certification as a means to attain a greater degree of proficiency.
For example, at the Mississippi Valley Health Network’s Orthopaedic Specialists, each surgeon is fellowship trained in a specific body part and performs hundreds of procedures related to that part of the anatomy. “We are proud that all of our surgeons are fellowship trained,” says Angie Van Utrecht, Orthopaedic Specialists Director of Operations. “Each is specifically trained on procedures related to hips, knees, hands, the spine, feet and ankles. After consultation, we refer our patients to the appropriate physician for the best procedure.”
Choosing the right anesthesia
So, you’ve picked the right surgeon and you need to learn about the procedure. Your surgeon should be able to explain alternative methods for completing the procedure, as well as specific risks associated with each one. You might even have choices in how to be anesthetized. The type of anesthesia plays an important part not just in the surgery, but also – even especially – in the recovery process, so it’s important to go over those options thoroughly.
“General anesthesia is no longer the only option for surgical procedures,” says John Dooley, M.D., and Anesthesiologist, of Davenport-based Anesthesia and Pain Consultants. “Depending upon the surgery being performed, we can anesthetize only the local area or region of the body utilizing nerve block technology. The feedback from patients is overwhelmingly positive. General anesthesia can have a number of uncomfortable side effects, from grogginess to nausea and vomiting. Those side effects – and the risk of deep vein thrombosis from being bedridden too long – can be greatly reduced by choosing something other than the standard answer,” says Dr. Dooley. “My goal is to ensure the patients are comfortable, but that they can be up and moving and on their way to recovery as quickly as possible.”
Reduce your risks – the advantages of outpatient surgery centers
You and your surgeon should also discuss how to minimize the general risks of being a surgical patient. Those risks can be real, too: Forbes Magazine recently reported that one in 200 patients who spend the night in a hospital will die because of medical error.
Medication errors are the most common risk of hospitalization. Ask your doctor if a hospital stay is a necessary part of your surgery. If it is, make sure you understand the systems in place to prevent errors and how you and your family can track administration of both your current and surgery-related prescriptions and dosages.
Among the specifically surgery-related medications you may be given are antibiotics to help prevent infections in your surgical wounds. According to the Centers for Disease Control and Prevention, 1.7 million infections occur in U.S. hospitals every year, and those infections cause 99,000 deaths. Forbes puts the mortality number over 100,000 – more than AIDS, breast cancer and automobile accidents, combined. An antibiotic is not always needed when you have surgery. Talk to your physician and ask if an antibiotic is necessary to reduce the risk of infection.
In recent years, as surgical techniques have evolved, more procedures are being performed within Ambulatory Surgery Centers (ASCs) and patients are realizing the benefits. In the Quad Cities, the Mississippi Valley Surgery Center has been in operation since 1996 and has become a viable alternative to traditional hospitalization for many surgical procedures; from total joint replacements to gall bladder surgery. The advantages are many including: lower exposure to diseased patients found in traditional hospitals; better operational efficiency which can result in reduced healthcare costs and convenient service; and quicker recovery because patients are encouraged to be ambulatory (or to move) and recover at home.
Families and patients also find the Mississippi Valley Surgery Center advantageous due to the quality of care. “Our lower patient-to-nurse ratio allows for more attentive care than traditional hospitals that have a medically diverse patient population to care for,” says Alison Beardsley, MVSC Manager. “We are built differently to perform surgeries for patients who don’t necessarily need to be hospitalized, and because patients are home, they recover quicker,” she adds. “Many Quad City area surgeons have privileges at the Surgery Center as well as the local hospitals, so patients do have a choice where a surgery is performed.”
Although many believe that extended observation and stay in a hospital ensures there are no complications, research is bearing out that the best place for recovery can be at home. ASCs consistently perform as well as, if not better than hospital outpatient departments when quality and safety is examined. A recent study included examination of rates of inpatient hospital admission and death in elderly patients following common outpatient surgical procedures in hospitals’ outpatient facilities and procedures in ASCs. Rates of inpatient hospital admission and death were lower in freestanding ASCs according to the Archives of Surgery, a monthly professional medical journal published by the American Medical Association.
“We are built differently to perform surgeries for patients who don’t necessarily ned to be hospitalized, and because patients are home, they recover quicker.”
-Alison Beardsley, Mississippi Valley Surgery Center
Patients can control costs
As healthcare costs rise patients are facing higher out-of-pocket expenses for healthcare in the form of increased co-payments and deductibles. However many people are also unaware that their choice of where a surgery or procedure is performed can make a difference in the cost for a patient. In many cases, a patient will pay less to have a procedure performed in an ASC compared to a hospital. Studies have shown that procedures performed at an ASC cost significantly less than the same procedure performed at a hospital setting, according to a November 2006 US GAO Congressional Committee’s report on Medicare.
Insurers are also taking note. In April, Wellmark Blue Cross and Blue Shield approved Mississippi Valley Surgery Center to perform total joint replacements in the outpatient setting. “Insurers are always considering safe and cost effective alternatives,” says Dr. John Hoffman, a fellowship trained surgeon at Orthopaedic Specialists, PC. “To pass muster with major insurance carriers validates our efforts to provide patients with not only a quality, but cost effective option for having their joint replaced.”
Ask what your surgeon’s fee is and what it covers. Surgical fees often also include visits after the operation. You will also get a bill from the facility for your care and from other providers related to your surgery such as anesthesiologists, radiologists, laboratories, etc. Before your operation, call your insurance company to verify coverage. They will also tell you how much of the costs your insurance will pay and what share you will have to pay.
The road to recovery
Finally, when considering surgical options, one of the most important factors should be length of stay and the recovery process. Longer isn’t necessarily better. Ask how long you will be in the hospital or ambulatory surgical facility. Will your family be allowed to visit 24/7? Family members not only play an important part in helping you to deal with medications and your doctors and nurses, their emotional and practical support can help speed recovery. And when it’s time to go home, family members can help make sure that discharge instructions regarding medications, post-surgical care, physical therapy, and the like are organized and complete.
Again, in many cases, an ambulatory surgical facility, such as Mississippi Valley Surgery Center is a viable choice for all kinds of procedures. “I had one Moline mother tell me she spent an entire morning at a local hospital for her child’s ear tube procedure in which the actual surgery time was 10 minutes,” says Ms. Beardsley. “Not only do we pride ourselves in the safety and quality of our services, but also in the convenient environment we offer patients and their families. As long as patients are recovering well, patients are discharged in a practical timeframe. The surgery process from admission to discharge does not need to take the whole day,” she adds.
“When it comes to quality surgical care, there is a growing consensus that informed health care choices do have an impact on the success of that surgery for patients,” says Dr. John Dooley, a founding partner of the Mississippi Valley Surgery Center. “While in the past, patients may have felt they had no power, they should know it’s their right to make the purchasing decision that’s best for them and their families.”
10 Questions to Ask:
- Can I choose the surgeon?
- Is the surgeon fellowship trained?
- What are the procedure’s risks?
- What are my anesthesia choices?
- Does the procedure need to be performed in the hospital?
- Can my care limit exposure to infections?
- Can scarring be minimized?
- What kind of I care will I receive?
- How fast can I recover at home?
- How much will it cost?
